Pain in the calf

Calf pain often feels like a nagging pain that comes from the depths.However, these pains, especially the chronic ones, are often of a rather superficial nature. They usually result from tension in the muscles, their fasciae or the connective tissue. These tensions can be felt from the outside as hardenings.

The pain increases with certain movements, such as kneeling down or jogging. The pain in the hollow of the knee can be explained by the course of the calf muscles. Important here is the large triceps surae muscle, which forms the curvature of the calf.

It consists of a superficial gastrocnemius muscle and a deep soleus muscle. The gastrocnemius muscle is a two-headed muscle that originates at the lower edge of the thigh bone, at the so-called epicondyles of the femur, and is located in the Achilles tendon. With its two heads, it limits the hollow of the knee to the right and left.

Pain in this muscle or even at its origins therefore radiates quickly into the popliteal fossa, or even develops in this fossa. Almost always movement restrictions can also be observed. Stretching the knee is difficult, but so is rolling of the feet, bending and stretching of the toes, bending and stretching of the ankle, and pro- as well as supination of the foot.

Deep vein thrombosis of the leg, also called phlebothrombosis, can cause severe pain in the area of the hollow of the knee. In combination with the pain in the hollow of the knee, pain and a feeling of tension in the groin or sole of the foot also occur. Externally, permanently dilated skin veins, so-called varicose veins, may be visible.

They are highly tortuous and occur particularly on the legs. They are caused by a weakness of the vein walls and increase in size over time. In most cases the left leg is affected.

At the beginning, so-called spider veins appear, which do not cause any further complaints and are only treated for optical reasons at most. As the disease progresses, however, the defective veins cause swelling and pain, as the blood flow in the leg is obstructed and the blood accumulates. The complaints occur particularly at high outside temperatures and after standing for a long time.

The swelling or pain makes walking more difficult, and the hollow of the knee can also be affected, since this is where the superficial veins of the lower leg and knee meet the lower popliteal vein. It carries venous blood from the lower leg and the hollow of the knee into the femoral vein, a large vein on the thigh. Therapeutically, so-called thrombolytics such as streptokinase and urokinase are used here to loosen the thrombus.

This treatment takes about 5-7 days. Afterwards, thrombosis prophylaxis is carried out with heparin or acetylsalicylic acid. There is also the possibility of a thrombectomy.

This is the surgical removal of a thrombus from a blood vessel. This is done by means of a catheter.

Synonyms in a broader sense: deep leg vein thrombosis; DVT; phlebothrombosis; venous thrombosis, pelvic vein thrombosis, venous thrombosis, blood clots, leg vein thrombosis, lower leg thrombosis, economy class syndrome, tourist class syndrome, aircraft thrombosis, varicosis
Place of the greatest pain: hollow of the knee indeterminate.
Radiation or origin often in the lower leg
PathologyCause: Superficial or deep venous sacculation occlusions.
Age: middle to higher age
Gender: no gender preference
Accident: Possible accident and leg immobilization (e.g. by plaster cast).
Type of pain: pressing, pulling
Pain development: slowly increasing
Pain occurrence: Pain at rest and during stress.
External aspects: Visible varicose veins. In case of deep thrombosis swelling and livid discoloration of the lower leg. Possible redness of the lower leg, always swelling, sometimes with shiny skin.
Partial fever

Pain in the hollow of the knee may also be caused by overloading the biceps femoris muscle. This muscle is located at the back of the thigh and belongs to the so-called ischiocrural musculature. It is two-headed and its long head originates from a bony prominence of the pelvic bone, the ischiadic tuber.

The short head originates from the thigh bone itself. After the two heads are joined, the muscle attaches to the fibula head of the fibula, thus limiting the knee to the outer edge. Between the muscle tendon and the knee joint there is still a bursa.

A stress-related disease of this tendon, which is called biceps tendon tendinosis (see below), can be extremely painful. The pain is located in the hollow of the knee and is felt as stinging and pulling and develops slowly.Affected are mainly people who are very active in sports. There are other synonyms for this tendon disease.

These are insertion tendopathy and myotendinosis. The term insertion tendopathy describes the localization of the disease very well. This is the transition from tendon to bone, the insertion.

The cause is almost always incorrect loading in people who are not sufficiently trained or overloading without sufficient rest periods in athletes. The tendon attachment is then swollen and fat degenerated. This can also be seen from the outside.

The pain then occurs mainly under stress. However, there is also pain under pressure and stretching. To relieve the pain, it is recommended to avoid incorrect and excessive strain.

Conservatively one works then still with heat therapy, tape dressings, shock wave and electrotherapy, as well as the injection of glucocorticoids. If no conservative therapy works, surgery can be performed. In this operation, the diseased tendon is severed.

Since this always results in functional limitations, surgery should only be considered after any conservative method. In addition to any kind of therapy, physiotherapy is recommended. Irritation, inflammation and, in the worst case, tears in the tendons of the popliteal fossa cause pain, which occurs mainly during movements and leads to restrictions in movement.

In the popliteal fossa, the tractus iliotibialis, a structure that runs from the iliac crest via the outer knee hump to the insertion on the upper lower leg, and the tendon of the biceps femoris muscle are frequently affected. Both tendons cause pain in the area of the outer popliteal fossa. Damage to the tendon of the semimembranosus muscle or the semitendinosus muscle, on the other hand, is responsible for tendon-related pain in the area of the inner popliteal fossa.

The irritation of these tendons is caused by heavy strain and friction between the tendon and a bony prominence, as is the case with the tractus iliotibialis, for example. This runs over a projection of the thigh, the condyylus lateralis femoris, against which it can rub under high load. If the irritation increases to an inflammation of the tendons, pain is present at rest and also at night.

The inflammatory pain is permanently present and can be improved by cooling. If one of these tendons tears, there is a loss of movement because the transmission of force is no longer guaranteed. This limitation particularly affects flexion in the knee joint.

Synonyms: Enthesiopathy Musculus biceps femoris
Place of the greatest pain: Outer hollow of the knee. Head of fibula (Caput fibulae).
Cause of Pathology: Overload-related tendon disease of the muscle biceps femoris of the back thigh at the head of the fibula (Caput fibulae).
Age: sporty active persons
Gender: no gender preference
Accident: No
Type of pain: stabbing, pulling.
Pain development: slowly increasing
Pain occurrence: load-dependent
External aspects: None, in case of prolonged symptoms tendon thickening may occur.